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To evaluate the effect of olfactory dysfunction on the course and severity of COVID-19 and its prognostic and predictive significance for COVID-19.Prospective case-control study.Ondokuz Mayıs University School of Medicine.Reverse transcription polymerase chain reaction (PCR)-positive patients, patients with COVID-19-related symptoms who had a negative PCR result, and healthy controls were included in the study. Clinicodemographic characteristics, inflammatory markers, and computed tomography stages were recorded. Disease progression and intensive care unit admission were registered. The visual analog scale (0, worst; 10, best) was used to evaluate subjective olfactory, taste, and nasal breathing ability, and the Sniffin' Sticks identification (SS-ID) test was used for psychophysical olfactory assessment.Mean SS-ID scores were significantly lower in the positive group (8.77) than in the negative (10.43) and healthy control (12.17) groups. VAS-smell scores were significantly lower and anosmia was more prevalent in PCR-positive patients (Olfactory dysfunction was detected objectively and subjectively in the PCR-positive group, and no difference was found in terms of taste function and nasal breathing. The severity and prognosis of COVID-19 are not exclusively dependent on olfactory dysfunction. The degree of olfactory dysfunction can be useful in predicting PCR positivity.

Objectives: Chronic hepatitis C (CHC) is now a more curable disease with new direct acting antivirals (DAA). Although high sustained virologic response rates, failures still occur in DAA regimens. Our objective in this study was to characterize the real-life presence of clinically relevant resistance - associated substitutions (RASs) in the HCV NS5A gene in CHC patients whose DAA regimen has failed. Methods: The study enrolled 53 CHC patients who experienced failure with DAA regimen as the prospective longitudinal cohort between 2017-2019. Genotypic resistance testing was performed via the viral population sequencing method and The Geno2pheno HCV tool was used for RAS analysis. Results: The most frequent failure category was relapse (88%) followed by non-responder (12%). For a total of 36% of patients, RASs was detected in NS5A, Y93H was the most detected RAS in GT1b infected patients (89%). Conclusions: This study establishes an HCV failure registry for Turkey in which samples were combined with clinical, virologic and molecular data of adult patients whose DAA therapy failed. RASs can occur in CHC patients with DAA treatment failures. Evaluation of RAS after DAA failure is very important before retreatment is initiated to prevent virologic failure. (C) 2020 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. WOS:000540737100014 32302766 Q2

WOS: 000531866700014 Objective: Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) continues to be one of the most important health, social and safety issues faced by the global community. In 2014, the United Nations HIV/AIDS joint program (UNAIDS) proposed a new target for global anti-retroviral treatment (ART) program. This new target, known as "90-90-90", recommends that by 2020, 90% of all people living with HIV will be knowing their HIV serology, 90% of all people with diagnosed HIV infection will be receiving ART and 90% of all people on ART will achieve viral suppression. The aim of our study was to evaluate the HIV/AIDS cohort data of our clinic in the context of "90-90-90" targets. Methods: The medical records of HIV-infected patients followed in the Department of Infectious Diseases and Clinical Microbiology Ondokuz Mayis University Faculty of Medicine between 2005 and 2018 were reviewed retrospectively. Results: In our clinic, 336 HIV-infected patients were followed during the study period. Of these patients, 284 (84.5%) were male. Of the 317 surviving patients, 240 (75.7%) were examined at the outpatient clinic at least once within the last 6 months and 239 (75.3%) were on ART. According to the latest laboratory results of 239 patients on ART, virological suppression was achieved in 206 (86.1%) patients. In the analysis of 33 patients with a detectable viral load on ART, it was found that 11 patients were on ART for less than 6 months, 8 patients did not use their medication regularly, and one patient did not have a test result. Conclusions: Although it was determined that "90-90-90" targets are achievable within the scope of the patient group that we serve in our hospital, the compilation of nationwide data and screening programs to identify all HIV-infected patients in the community, will be guiding to achieve "90-90-90" targets.

Bu çalışma, 14-17 Eylül 2016 tarihleri arasında Lizbon[Portekiz]'de düzenlenen 19. Meeting of the European Society for Clinical Virology'de bildiri olarak sunulmuştur. Background: Because of their similar modes of transmission, the simultaneous infection of viral hepatitis and human immunodeficiency virus are increasingly seen as a big problem related to human health. Aims: To determine the drug mutations in hepatitis B virus and/or hepatitis C virus co-infected human immunodeficiency virus-1 patients in Turkey. Study Design: Retrospective cross-sectional study. Methods: The present study was conducted between 2010 and 2017. HBsAg, anti-hepatitis C virus, and anti-human immunodeficiency vim were tested with ELISA. All anti-human immunodeficiency virus positive results by ELISA were verified for anti-human immunodeficiency virus positivity by a Western blot test, and Antihuman immunodeficiency virus positive patients with HBsAg andior anti-hepatitis C virus positivity were included in the study. Subtyping and genotypic resistance analyses were performed by population sequencing of the viral protease and reverse transcriptase regions of the human immunodeficiency virus-1 pol gene. Results: We detected 3896 human immunodeficiency virus-1 positive patients whose sera were sent from numerous hospitals across the country to our polymerase chain reaction unit for detection of drug resistance mutations and whose molecular laboratory tests were completed. Viral hepatitis co-infections were detected in 4.3% (n=170) of patients. Hepatitis B virus and hepatitis C virus co-infection were observed in 3.2% and 0.5% of all human immunodeficiency virus-I infected patients, respectively. The major human immunodeficiency virus-1 subtype detected was group M, subtype B (62.9%). However, 13.5% of drug resistance mutation motifs were found in human immunodeficiency virus-1 genomes of patients included in the study. Conclusion: Due to similar transmission routes, HIV1 patients are at risk of hepatitis B and C virus co-infection. However, antiretroviral drug resistance mutation model is similar to patients with hepatitis negative. European Society for Clinical Virology

Purpose: To investigate the frequency of concurrent drug use and drug interactions in patients with human immunodeficiency virus (HIV) infection. Methods: The medical records of HIV-infected patients followed up at Ondokuz Mayis University Hospital in the last six months were retrospectively reviewed to assess the antiretroviral therapy (ART) regimens used, the prescribed concurrent drugs, and their interactions Results: The records of 268 patients were evaluated; of these, 43 (16 %) were women, and 225 (84 %) were men. The mean age of the patients was 43.8 ± 12.1 years. Concurrent drugs were prescribed to 210 (78.3 %) patients. Drug interactions were detected in 115 (42.9 %) patients. Of the 210 drug interactions detected, 168 (80 %) were potential interactions, 39 (18.6 %) were weak interactions, and 3 (1.4 %) were contraindicated. A statistically significant relationship was not observed in gender, age, and rate of concurrent drug prescription. Increased nephrotoxicity was the most common potential drug interaction. Non-steroidal anti-inflammatory drugs were the most commonly prescribed class of drugs along with ART. Conclusion: Physicians treating HIV-infected patients should be conscious of, and careful about the concurrent use of drugs and their potential drug interactions.

Introduction/Aim: Hyponatremia (serum sodium 0.001) were the independent predictors of hyponatremia at the time of admission. The median length of hospital stay (LOS) was longer in patients with hyponatremia than patients with normonatremia (10 days vs. 8 days, p < 0.001). In multivariate analysis, hyponatremia was significantly associated with ICU admission or the need for mechanical ventilation (adjusted OR, 1.72; 95% confidence interval [95% CI], 1.03 to 2.85; p = 0.036). The severity of pneumonia, hemoglobin and lactate dehydrogenase levels, neutrophil-to-lymphocyte ratio (NLR), and body temperature were also associated with ICU admission or the need for mechanical ventilation. The oxygen saturation, male sex, serum albumin, NLR, and the ICU admission but not the hyponatremia on admission were significantly related to mortality. Conclusion: Hyponatremia on admission, even when mild, predicts a worse outcome in COVID-19 patients, and it should be considered in risk stratification.

Gunal, Ozgur/0000-0002-7744-4123; KARABAY, OGUZ/0000-0003-1514-1685 WOS: 000490537600009 PubMed: 31580558 Objective: Treponema pallidum and HIV are transmitted frequently through sexual contact, these agents with epidemiological similarities co-infect the same host. The current number of HIV-infected cases in Turkey is increasing. For this reason, we aimed to reveal the characteristics of syphilis in HIV/AIDS cases. Methods: A retrospective longitudinal cohort study was performed, patients were followed up at 24 clinics in 16 cities from all seven regions of Turkey between January 2010 to April 2018. We examined the socio-demographic characteristics, laboratory parameters and neurosyphilis association in HIV/AIDS-syphilis co-infected cases. Results: Among 3,641 patients with HIV-1 infection, 291 (8%) patients were diagnosed with syphilis co-infection. Most patients were older than 25 years (92%), 96% were males, 74% were working, 23% unemployed, and 3% were students. The three highest prevalence of syphilis were in Black Sea (10.3%), Mediterranean (8.4%) and Marmara Regions (7.4%). As for sexual orientation, 46% were heterosexuals, 42% men who have sex with men (MSM), and no data available for 12%. Patients with the number of CD4+

Objective: Pneumocystis jirovecii pneumonia (PCP) is still a critical opportunistic infection in patients diagnosed with the human immunodeficiency (HIV) infection in the advanced stages and patients who do not adhere to antiretroviral therapy. This study aimed to evaluate the clinical and diagnostic features of PCP infections developed in HIV-infected patients.Methods: HIV-infected patients aged 18 years and older, followed between January 2005 and March 2020 at the university hospital, were retrospectively reviewed from medical records. Results: Within the study's scope, 397 HIV-infected patients, 62 (15.6%) females and 335 (84.4%) males, with a mean age of 39.2 ± 11.6 years, were evaluated. While age was not a risk factor for developing PCP, the male gender was a risk factor. Patients with PCP had significantly lower CD4 lymphocytes counts than patients without PCP, and a CD4 lymphocyte count, Amaç: Pneumocystis jirovecii pnömonisi (PCP), insan immünyetmezlik virüsü (HIV) ile enfekte ileri evre hastalarda ve antiretroviral tedavilerine uymayan kişilerde hala kritik bir fırsatçı enfeksiyondur. Bu çalışma, HIV ile enfekte hastalarda gelişen PCP enfeksiyonlarının klinik ve tanısal özelliklerini değerlendirmeyi amaçlamaktadır.Yöntem: Ocak 2005 ile Mart 2020 arasında üniversite hastanesinde izlenen 18 yaş ve üstü HIV ile enfekte hastaların tıbbi kayıtları geriye dönük olarak incelendi.Bulgular: Çalışma kapsamında; 62'si (%15,6) kadın, 335’i (%84,4) erkek ve yaş ortalaması 39,2 ± 11,6 yıl olan 397 HIV ile enfekte hasta değerlendirildi. Yaş, PCP'yi gelişimi açısından bir risk faktörü olarak bulunmasa da erkek cinsiyet risk faktörü olarak saptandı. PCP'li hastalar, PCP'si olmayan hastalara göre önemli ölçüde daha düşük CD4 lenfosit sayılarına sahipti ve CD4 lenfosit sayısının

Crimean–Congo haemorrhagic fever (CCHF) is a severe form of haemorrhagic fever identified in parts of Africa, Asia, Eastern Europe and the Middle East. CCHF continues to be a justifiable cause of concern for people in rural areas where the disease is endemic. A total of 151 patients, diagnosed with CCHF, were evaluated retrospectively. The demographic characteristics of these patients and the relationship between the neutrophil–lymphocyte ratio (NLR) at admission and survival were examined. There were 21 (13.9%) deaths. There was no relationship between age, gender and mortality, but elevated neutrophil–lymphocyte ratio (NLR) on admission was statistically associated with mortality. NLR is a laboratory marker that can be studied even in medical centres with limited facilities and may be helpful in predicting the clinical course of the disease.

Tam Metin / Full Text Introduction: Tuberculosis (TB) still continues to be the leading cause of death for Human Immunodeficiency Virus (HIV) infected patients, and it accounts for approximately one of three acquired immunodeficiency syndrome (AIDS) related deaths. The study aimed to analyze clinical and laboratory data of Mycobacterium tuberculosis infection in HIV infected patients. Materials and Methods: Medical records of adult (aged≥ 18 years) HIV infected patients diagnosed and under medical care between January 2005 and November 2018 were obtained and analyzed retrospectively by searching hospital database system.Results: Fifteen patients (4.5%) had TB among the 336 HIV infected patients. There was no statistically significant difference between the age of HIV-infected patients with and without TB disease (38.07 ± 8.48 vs 39.26 ± 11.67; p: 0.697). Diagnosis of TB disease and HIV infection were concurrent during presentation in 9 (60%) patients, while six (40%) patients had a previous history of HIV infection and treatment. Five (83.3%) of 6 patients receiving antiretroviral therapy (ART) had no viral suppression due to non-adherence. Median CD4 T lymphocyte count was 114/mm3 (0-436) at the time of TB diagnosis whereas it was 408/mm3 (1-1734) in those without TB disease at the time of initial HIV infection diagnosis, and the difference was statistically significant (p< 0.05). Odds ratio for CD4 T lymphocyte count less than 200 in HIV infected patients with TB disease was 14.89 (confidence interval 95%: 4.08-54.34). While ten (66.7%) patients had pulmonary involvement, five (33.3%) patients had extrapulmonary involvement. There was no statistically significant difference between the median CD4 T lymphocyte counts of patients with pulmonary involvement (107/mm3, range:0-436) and extrapulmonary involvement (140/mm3, range: 86-259) (p= 0.391). Conclusion: Tuberculosis disease should be considered in patients who have applied at advanced stages of HIV infection or whose virological suppression could not be achieved due to incompatibility with ART treatment. Giriş: Tüberküloz (TB), İnsan immün yetmezlik virüsü (Human immunodeficiency virus: HIV) ile infekte hastalarda önde gelen ölüm nedeni olmaya devam etmekte olup, kazanılmış immün yetmezlik sendromu (Acquired immunodeficiency syndrome: AIDS) ile ilgili her üç ölümden yaklaşık birinin nedenini oluşturmaktadır. Bu çalışmada HIV ile infekte hastalarda gelişen TB hastalığının klinik ve labora-tuvar verilerinin irdelenmesi amaçlandı. Materyal ve Metod: Ocak 2005 ve Kasım 2018 tarihleri arasında HIV tanı ve tedavisi alan 18 yaş ve üzerindeki hastalar çalışmaya dahil edildi. Hastaların verileri hastane otomasyon kayıt sistemi taranarak retrospektif olarak elde edildi. Bulgular: Çalışma döneminde 336 HIV ile infekte hasta tespit edildi. Hastaların 15'inde (%4.5) TB hastalığı saptandı. TB hastalığı olan ve olmayan HIV ile infekte hastaların yaş ortalaması (38.07 ± 8.48 vs 39.26 ± 11.67) arasında istatiksel olarak anlamlı bir fark yoktu (p:0.697). TB hastalığı tanısı, dokuz (%60) hastada HIV infeksiyonu tanısı aldığı anda konulurken, altı (%40) hastada ise daha önceden HIV infeksiyonu ve tedavisi öyküsü vardı. Antiretroviral tedavi (ART) deneyimli olan beş hastada tedavi uyumsuzluğu nedeniyle viral baskılanma sağlanmamıştı. TB hastalığı olan HIV ile infekte hastalarda TB tanısı sırasında ortanca CD4 T lenfosit sayısı 108/mm3 (0-436); TB hastalığı olmayanlarda HIV infeksiyonunun tanısı sırasında ise 408/mm3 (1-1734) olarak belirlendi ve aradaki fark istatistiksel açıdan anlamlıydı (p< 0.05). TB hastalığı olan HIV ile infekte hastalarda CD4 T lenfosit sayısının 200/mm3‘ün altında olma Odds oranı 14.89‘du (%95 güven aralığı: 4.08-54,34). Hastaların onunda (%66.7) akciğer tutulumu mevcutken beş (%33.3) hastada ise ekstrapulmoner tutulum mevcuttu. Akciğer tutulumu olan hastalar medyan CD4 T lenfosit sayısı 107/mm3 (0-436) iken ekstrapul-moner tutulumu olan hastalarda ise 140/mm3‘tü (86-259) ve her iki grup arasında istatiksel açıdan anlamlı bir fark yoktu (p= 0.391).Sonuç: HIV infeksiyonunun ilerlemiş evrelerinde başvuran veya ART tedavisine uyumsuzluk nedeni ile virolojik baskılanma sağlanama-mış hastalarda tüberküloz hastalığı göz önünde bulundurulmalıdır.

Human toxocariasis is a parasitic disease transmitted to humans by ingestion of Toxocara spp. larvae. Rural area residents and children have higher risk for this parasitic infection. The disease is frequently asymptomatic; however, it may cause symptoms such as cough, fever, headache, myalgia or other conditions such as lymphadenopathy and granulomatous hepatitis. Albendazole is used for the treatment of toxocariasis diagnosed by serologic and immunological methods. Herein, we report two cases of toxocariasis that were investigated due to hypereosinophilia and lymphadenopathy for a long time.

Purpose The objective of this study is to evaluate smell and taste dysfunction (STD) in coronavirus disease 2019 (COVID-19) positive and negative patients, and to assess the factors associated with STD in COVID-19 positive patients. Methods Patients who had been tested with the real-time reverse transcriptase-polymerase chain reaction (RT-PCR) for COVID-19 were identified, and according to the RT-PCR test results, patients were separated into Positive and Negative Groups. A telephone-based assessment was applied to both groups using the American Academy of Otolaryngology–Head and Neck Surgery Anosmia Reporting Tool. Patients in Positive Group were also asked to rate STD, nasal breathing, and anxiety in three different time periods (pre-/during-/post-COVID) using the visual analog scale (VAS). Results A total of 53 COVID-19 positive and 51 negative patients completed the surveys. STD was eightfold more frequent (OR 8.19; CI 95% 3.22–20.84) in the Positive Group. Of the 53 COVID-19 positive patients, 32 reported STD and 21 did not. ‘Ground-glass appearance’ on chest-computed tomography was more frequent and median lymphocyte count was significantly lower in COVID-19 positive patients with STD. During-COVID STD and nasal breathing VAS scores were significantly lower than the pre- and post-COVID scores. During-COVID STD scores were significantly correlated with anxiety scores (Spearman’s rho-0.404, p = 0.022) but not correlated with nasal breathing scores. Conclusion STD may be related to increased inflammatory response as well as damage of olfactory neuronal pathway or non-neuronal olfactory mucosa. Understanding the exact cause of chemosensory impairment in COVID-19 can be helpful in explaining the pathophysiology of the disease. Electronic supplementary material The online version of this article (10.1007/s00405-020-06503-9) contains supplementary material, which is available to authorized users.

IntroductionInfections such as viral hepatitis and syphilis that share similar transmission routes with human immunodeficiency virus (HIV) may adversely affect the course of the disease. We aimed to determine the seroprevalence of viral hepatitis and syphilis among HIV-infected people at the initial stage of diagnosis.Material and methodsThe medical records of 336 HIV-infected people aged 18 years and older, who were followed up between 2005 and 2018 at a university hospital in Samsun, Turkey, were evaluated retrospectively in terms of initial serological markers for viral hepatitis and syphilis.ResultsHepatitis B surface antigen (HBsAg) was positive in 13 (4.2%) of 303 patients, antibody to HBs antigen (anti-HBs) in 117 (39.2%) of 298 patients, antibody to hepatitis C virus (anti-HCV) in 3 (0.9%) of 301 patients, total antibody to hepatitis B core antigen (anti-HBc total) in 70 (29.2%) of 239 patients and total antibody to hepatitis A virus (anti-HAV total) in 224 (84.5%) of 265 patients. Hepatitis B virus (HBV) deoxyribonucleic acid (DNA) was detected in one (12.5%) of eight patients with isolated anti-HBc. Of 224 patients who were examined for syphilis, 34 (15.1%) were positive for Treponema pallidum hemagglutination (TPHA).ConclusionsIn our study, high seroprevalence of syphilis and low immunity to HBV were detected. Health care facilities that follow up HIV-infected people should determine the serological profiles initially once the patients are diagnosed. It should be kept in mind that due to behavioral risk factors among HIV-infected people prevalence of coinfections may be higher than the rate in the community.

Introduction: Enterococcus hirae (E. hirae) constitutes less than 1% of the enterococci strains in human clinical specimens. In this article, we report the first case of urinary tract infection-related bacteremia due to E. hirae from Turkey. Case Presentation: A 74-year-old male patient with a history of coronary artery disease, hypertension, and chronic renal failure was admitted to the emergency department with abdominal pain, dysuria, and fever. The urine sample collected from the urinary catheter resulted as ampicillin-sensitive E. hirae. On the 4th day of hospitalization, E. hirae growth with the same sensitivity pattern was also reported in blood culture. Intravenous ampicillin 4×2 g/day treatment was initiated. There was no growth in subsequent blood and urine cultures. Fever resolved and general condition improved. The patient was discharged on the thirteenth day with clinical improvement after moxifloxacin treatment for four days and ampicillin treatment for nine days. Discussion: The patient's medical history included risk factors for enterococcal bacteremia. There are a limited number of reports in the literature describing human infections caused by E. hirae. The reason for the rare isolation of E. hirae from clinical specimens may be the difficulty of identifying with standard diagnostic approaches. Conclusions: For diagnostic purposes, as in our case, rapid and high sensitive diagnostic methods such as Matrix-assisted Laser Desorption/Ionization Time of Flight (MALDI-TOF) and molecular techniques may be useful to guide the selection of the least toxic and optimal duration of antibiotic treatment.

Background: Because of their similar modes of transmission, thesimultaneous infection of viral hepatitis and human immunodeficiencyvirus are increasingly seen as a big problem related to human health.Aims: To determine the drug mutations in hepatitis B virus and/or hepatitis C virus co-infected human immunodeficiency virus-1patients in Turkey.Study Design: Retrospective cross-sectional study.Methods: The present study was conducted between 2010 and 2017.HBsAg, anti-hepatitis C virus, and anti-human immunodeficiencyvirus were tested with ELISA. All anti-human immunodeficiencyvirus positive results by ELISA were verified for anti-humanimmunodeficiency virus positivity by a Western blot test, and Antihuman immunodeficiency virus positive patients with HBsAg and/oranti-hepatitis C virus positivity were included in the study. Subtypingand genotypic resistance analyses were performed by populationsequencing of the viral protease and reverse transcriptase regions ofthe human immunodeficiency virus-1 pol gene.Results: We detected 3896 human immunodeficiency virus-1 positivepatients whose sera were sent from numerous hospitals across thecountry to our polymerase chain reaction unit for detection of drugresistance mutations and whose molecular laboratory tests werecompleted. Viral hepatitis co-infections were detected in 4.3% (n=170)of patients. Hepatitis B virus and hepatitis C virus co-infection wereobserved in 3.2% and 0.5% of all human immunodeficiency virus-1infected patients, respectively. The major human immunodeficiencyvirus-1 subtype detected was group M, subtype B (62.9%). However,13.5% of drug resistance mutation motifs were found in humanimmunodeficiency virus-1 genomes of patients included in the study.Conclusion: Due to similar transmission routes, HIV1 patients are atrisk of hepatitis B and C virus co-infection. However, antiretroviraldrug resistance mutation model is similar to patients with hepatitisnegative.

Deaths related with human immunodeficiency virus (HIV) infections have been decreased by the introduction of combined anti-retroviral therapy (ART) into the clinical practice. Combined ART usually consists of two nucleoside/nucleotide analogs reverse transcriptase inhibitors (NRTI) that is called backbone and a third drug that belongs to either non-nucleoside/nucleotide reverse transcriptase inhibitors (NNRTI), protease inhibitors (PI), integrase strand transfer inhibitors (INSTI) or entry inhibitors. During abacavir therapy which is a member of NRTI, hypersensitivity reactions can occur approximately 4-9% of the patients that lead difficulties for the management of HIV infections. It is known that, the development of hypersensitivity reactions to abacavir is strongly associated with the presence of HLA-B*57:01 allel, therefore, HLA-B*57:01 screening should be performed prior to abacavir use. Since there is no data on HLA-B*57:01 prevalence in HIV-1-infected cases in Turkey, this is the first study that screened HLA-B*57:01 allels among HIV-1 infected adults in Turkey. A total of 100 HIV-1-infected patients (81 male, 19 female; mean age: 42.31±11.97 years) who have admitted to the Department of Infectious Diseases and Clinical Microbiology of Ondokuz Mayis University School of Medicine, Samsun, Turkey, were included in the study. Genomic DNAs were isolated from the blood samples of patients by using a commercial spin column procedure (QIAamp® DNA Blood Mini Kit; QIAGEN GmbH, Germany). HLA-B*57:01 genotyping was performed by the method of sequence-specific primer (SSP)-based amplification using a commercial OlerupSSP® HLA-B*57:01 high-resolution test kit (Olerup SSP AB, Sweden) according to the manufacturer's protocol. The products of polymerase chain reaction were electrophoresed on a 2% agarose gel stained with Olerup SSP GelRed dye (Olerup SSP AB, Sweden), and the bands were evaluated under UV light. In our study, three (2 male, 1 female) out of 100 patients were found positive for HLA-B*57:01 gene with a prevalence of 3%, which is a moderate level. Although the medical usefulness of HLA-B*57:01 screening before the abacavir therapy is emphasized, it was also noted that this application is not cost-effective for the populations with low HLA-B*57:01 prevalence, in contrast to populations with high prevalence. Considering of the incidence of HIV/AIDS in Turkey which is 0.12, the value and cost-effectiveness of HLA-B*57:01 screening in HIV-1 positive cases before abacavir therapy should be analysed by further studies.

cerik, idris bugra/0000-0003-1419-3950 WOS: 000471831300013 PubMed: 31038789 Background Pulmonary hypertension (PH) is one of the complications of human immunodeficiency virus (HIV) infection. Despite the emergence of effective therapies, pulmonary arterial hypertension is commonly seen, especially at advanced stages. At the time of diagnosis, a majority of patients are at New York Heart Association-Functional Class III or IV. Many of the current screening modalities are dependent on detecting a rise in pulmonary arterial pressure (PAP). However, high capacitance of the pulmonary circulation implies that early microcirculation loss is not accompanied by a change in resting PAP. Therefore, we aimed to demonstrate early changes in pulmonary vascular disease in HIV-infected patients with a new echocardiographic parameter, called as pulmonary arterial stiffness (PAS). Methods and Results Thirty-six HIV-infected patients and 36 age- and sex-matched healthy control subjects were enrolled in this study. PAS was calculated echocardiographically by using maximal frequency shift and acceleration time of the pulmonary artery flow trace. There was no significant difference in diastolic functions, right ventricular diameters, systolic PAP, inferior vena cava widths, right atrial area, and tricuspid annular plane systolic excursion values between the two groups. However, PAS was calculated as 24.3 +/- 6.4 Hz/msn in HIV-infected patients and 19.3 +/- 3.1 Hz/msn in healthy control group (P < 0.001). Increase in PAS was correlated with duration of HIV infection (P < 0.05). Conclusion Our results suggest that HIV infection affects pulmonary vascular bed starting early onset of disease and this can be demonstrated by an easy-to-measure echocardiographic parameter.

Cryptococcus neoformans is an opportunistic fungal agent, which may cause infectiondepending on the state of immunity. The agent is especially prone to be localized in the centralnervous system. Fingolimod is an immunomodulatory drug that is used in the treatment of Multiple Sclerosis (MS). The use of this drug leads to a decrease in lymphocyte count and thus might result in the occurrence of the opportunistic infections like Cryptococcosis. In this article, we presenta MS patient that underwent fingolimod treatment and developed Cryptococcus meningoencephalitis.

Deaths related with human immunodeficiency virus (HIV) infections have been decreased by the introduction of combined anti-retroviral therapy (ART) into the clinical practice. Combined ART usually consists of two nucleoside/nucleotide analogs reverse transcriptase inhibitors (NRTI) that is called backbone and a third drug that belongs to either non-nucleoside/nucleotide reverse transcriptase inhibitors (NNRTI), protease inhibitors (PI), integrase strand transfer inhibitors (INSTI) or entry inhibitors. During abacavir therapy which is a member of NRTI, hypersensitivity reactions can occur approximately 4-9% of the patients that lead difficulties for the management of HIV infections. It is known that, the development of hypersensitivity reactions to abacavir is strongly associated with the presence of HLA-B*57:01 allel, therefore, HLA-B*57:01 screening should be performed prior to abacavir use. Since there is no data on HLA-B*57:01 prevalence in HIV-1-infected cases in Turkey, this is the first study that screened HLA-B*57:01 allels among HIV-1 infected adults in Turkey. A total of 100 HIV-1-infected patients (81 male, 19 female; mean age: 42.31±11.97 years) who have admitted to the Department of Infectious Diseases and Clinical Microbiology of Ondokuz Mayıs University School of Medicine, Samsun, Turkey, were included in the study. Genomic DNAs were isolated from the blood samples of patients by using a commercial spin column procedure (QIAamp® DNA Blood Mini Kit; QIAGEN GmbH, Germany). HLA-B*57:01 genotyping was performed by the method of sequence-specific primer (SSP)-based amplification using a commercial OlerupSSP® HLA-B*57:01 high-resolution test kit (Olerup SSP AB, Sweden) according to the manufacturer's protocol. The products of polymerase chain reaction were electrophoresed on a 2% agarose gel stained with Olerup SSP GelRed dye (Olerup SSP AB, Sweden), and the bands were evaluated under UV light. In our study, three (2 male, 1 female) out of 100 patients were found positive for HLA-B*57:01 gene with a prevalence of 3%, which is a moderate level. Although the medical usefulness of HLA-B*57:01 screening before the abacavir therapy is emphasized, it was also noted that this application is not cost-effective for the populations with low HLA-B*57:01 prevalence, in contrast to populations with high prevalence. Considering of the incidence of HIV/AIDS in Turkey which is 0.12, the value and cost-effectiveness of HLA-B*57:01 screening in HIV-1 positive cases before abacavir therapy should be analysed by further studies.

Sayan, Murat/0000-0002-4374-7193; Gunduz, Alper/0000-0001-9154-844X; ULCAY, ASIM/0000-0003-0531-0668 WOS: 000375126200003 PubMed: 27125365 Objectives: Integrase strand transfer inhibitor (INSTI) is a new class of antiretroviral (ARV) drugs designed to block the action of the integrase viral enzyme, which is responsible for insertation of the HIV-1 genome into the host DNA. The aim of this study was to evaluate for the first time INSTI resistance mutations in Turkish patients. Methods: This study was conducted in Turkey, between April 2013 and April 2015 using 169 HIV-1-infected patients (78 ARV naive patients and 91 ARV-experienced patients). Laboratory and clinical characteristics of ARV naive and ARV-experienced patients were as follows: gender (M/F): 71/7 and 80/11, median age: 38 and 38.4; median CD4+ T-cell: 236 and 216 cells/mm3, median HIV-1 RNA: 4.95+ E5 and 1.08E+ 6 copies/ml. Population-based seqeunces of the reverse transcriptase, protease, and integrase domains of the HIV-1 pol gene were used to detect HIV-1 drug resistance mutations. Result: INSTI resistance mutations were not found in recently diagnosed HIV-1-infected patients. However, ARV-experienced patients had major resistance mutations associated with raltegravir and elvitegravir; the following results were generated: F121Y, Y143R, Q148R and E157Q (6/91 - 6.6%). Conclusions: The prevalence of INSTI resistant mutations in ART-experienced patients suggested that resistance testing must be incorporated as an integral part of HIV management with INSTI therapies.

WOS: 000350946600012 PubMed: 25706737 Aeromonas spp. are oxidase positive, gram-negative, facultative anaerobic bacilli that are widely distributed in aquatic environments. A.hydrophila, A.sobria and A.bestiarum may cause severe infections in both human and cold-blooded animals. Environmental persistance of quinolones that are widely used in both human and veterinary medicine plays an important role in the selection of resistant mutants. Plasm id-mediated resistance is one of the main mechanisms involved in quinolone resistance, and qnr, qepA, aac(6')-Ib-cr, oqxAB genes are identified as resistance determinants. Determination of various types of qnr gene in different bacteria mainly in Enterobacteriaceae, suggests that they are widely distributed in nature. Recently, plasmid-mediated quinolone resistance was defined among Aeromonas species isolated from water. The aim of this study was to investigate the presence of qnr genes among aquatic Aeromonas spp. in Turkey. A total of 45 Aeromonas strains isolated from water and fishes collected from three different geographical regions (Aegean, Mediterranean and Blacicsea) in Turkey, were included in the study. The isolates were identified at species level by the use of 16S rDNA-RFLP (Restriction fragment length polymorphism) analysis and multiplex polymerase chain reaction (M-PCR). Among the isolates, 20 were identified as A.sobria, 10 as A.hydrophila, nine as A.salmonicida, four as A.bestiarum and two as A.veronii. The plasmid-mediated quinolone resistance determinants, qnrA, qnrB, qnrC and qnrS genes, were investigated by M-PCR, and sequence analysis was performed for nine qnr-positive isolates. According to the sequence analysis of the genes, qnr genes were characterized in six A.sobria, in two A.bestiarum and in one A.hydrophila isolate (9/45; 20%). When the sequence was compared with GenBank database, this gene was found as qnrS2. All qnrS-positive Aeromonas spp. isolates were ciprofloxacin-susceptible, while five of them were resistant to nalidixic acid. This study is the first research about the plasmid-mediated quinolone resistance and the presence of qnrS2 genes among Aeromonas spp. isolated from fishes and water in Turkey. In conclusion, various resistance genes of aquatic bacteria may constitute a potential risk for the transmission of those genes to other bacteria as well as clinical isolates.

WOS: 000291319200022 PubMed: 21655831 The susceptibility of 49 Mycobacterium tuberculosis clinical isolates to isoniazid (INH) and rifampisin (RIF) (28 multi-drug resistant-tuberculosis samples) was determined by a nitrate reductase assay (NRA) on blood agar. Agreement between the NRA and other testing methods was found to be 93.8% for both INH and RIF. The sensitivity, specificity, positive predictive value and negative predictive value for INH were 92.8%, 94.2%, 86.6% and 97%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value for RIF were 90.4%, 96.4%, 95% and 93.1%. In conclusion, we show here that blood agar can be used effectively for the NRA test.

Low virulent Citrobacter koseri can cause life threatening infections. Neonates and other immunocompromised patients are particularly susceptible to infection from C. koseri. Any infection due to C. koseri mandates antimicrobial therapy based on the sensitivity of the pathogen microorganism. Various types of antibiotics, including aminoglycosides carbapenems, cephalosporins, chloramphenicol and quinolones, are used for the treatment of C. koseri infections. The rational choice of antimicrobial therapy for Citrobacter infections is a challenge for clinicians because there is a sustained increase in antibacterial resistance. We reviewed antimicrobial agents used for C. koseri infections in this review.

Colorimetric phenotypic tests recently gained interest because traditional primary drug susceptibility testing of Mycobacterium tuberculosis isolates takes a long time. We used meta-analysis techniques to review the reliability and accuracy of the nitrate reductase assay (NRA), which is one of the most popular colorimetric methods to detect resistance to first-line drugs. Medline, PubMed, ISI Web, Web of Science, and Google Scholar were used to search for studies enrolled in the meta-analysis. The analysis included 35 studies for isoniazid (INH), 38 for rifampin (RIF), and 22 for ethambutol (EMB) and streptomycin (STR). Summary receiver operating characteristic (SROC) curves were applied to summarize diagnostic accuracy. The meta-analyses were performed by the use of Meta-DiSc software (version 1.4) and were focused on sensitivity and specificity values for measurements of accuracy. The pooled sensitivities were 96% for INH, 97% for RIF, 90% for EMB, and 82% for STR. The pooled specificities for INH, RIF, EMB, and STR were 99%, 100%, 98%, and 96%, respectively. The times required to obtain results were between 5 and 28 days by the direct NRA and between 5 and 14 days by the indirect test. In conclusion, the present meta-analysis showed that the NRA is a reliable low-cost rapid colorimetric susceptibility test that can be used for the detection of multidrug-resistant (MDR) tuberculosis, including detection of EMB resistance. However, the test appears to have a relatively low sensitivity for STR and needs further improvement.

WOS: 000309262100001 PubMed: 23182043 Treatment of multidrug resistant (MDR) Acinetobacter baumannii infections causes some problems as a result of possessing various antibacterial resistance mechanisms against available antibiotics. Combination of antibiotics, acting by different mechanisms, is used for the treatment of MDR bacterial infections. It is an important factor to determine synergy or antagonism between agents in the combination for the constitution of effective therapy. The study aimed to determine in vitro interactions interpreted according to calculated fractional inhibitory concentration (FIC) index between sulbactam and ceftazidime, ceftriaxone, cefepime, ciprofloxacin, gentamicin, meropenem, tigecycline, and colistin. Ten clinical isolates of A. baumannii were tested for determination of synergistic effects of sulbactam with different antimicrobial combinations. Minimal inhibitory concentration (MIC) values of both sulbactam and combined antibiotics decreased 2- to 128-fold. Synergy and partial synergy were determined in combination of sulbactam with ceftazidime and gentamicin (FIC index: 0.5 to 0.5 to 1-2) in six isolates. Antagonism was not determined in any combination for clinical A. baumannii isolates in the study. In conclusion, sulbactam is a good candidate for combination treatment regimes for MDR A. baumannii infections.

Tez (yüksek lisans) - Anadolu Üniversitesi, Anadolu Üniversitesi, Güzel Sanatlar Enstitüsü, Resim Anasanat Dalı, Kayıt no: 155793, Kentlilerin ortaya çıkışlarından itibaren insanlık tarihinin evrimi, öncelikle kent yaşamı ekseninde değişmiş ve gelişmiştir. Bu genel değerlendirme kenti, değişik bilim disiplinlerinin, bilimsel olmayan bigi alanlarının ve sanatın konusu olmasına yetmemektedir. Kente bir çok açıdan yaklaşılabilir: Planındaki organik veya yapay düzenler itibariyle, nostaljiyle, tarihiyle, sınıfsal çözümlemelerle, estetikle, kent sahiplerinin kentleri hakkında ne düşündükleriyle... Nihayet yine kentte yaşayan insanların katılımı ile oluşan kentlerin imgesi ile de kente yaklaşmak mümkündür. Bir kent çalışmasının içeriği ne olursa olsun, kentler için sosyolojik çözümlemeler ve tarihsel evrim dikkate alınması gereken alanlardır. Bu anlamda endüstri kentlerinin yaygınlaştığı dönemde, bugün tartışmalı olsalar bile XIX. yüzyıl sosyolog ve felsefecilerinin görüşleri bir hareket noktası oluşturmaktadır. Bu pozitivist kuramcıları günümüze kadar başka kuramsal yaklaşımlar izlemiştir. Resimde kent imgesi için, imgenin kavramsal anlamı ve kentlerin imgesinden neler kastedildiği açıklıkla ortaya konması gerekir. İmge teriminin sözlük anlamı ile kavramsal anlamı arasındaki derin bilgi alanları kentlerin imgesi için daha da belirgindir. Sanatsal değerlendirmelerde imgenin sadece zihinde beliren nesnelerin ikinci türden görünümleri olmadığı, aynı zamanda sanat kuramları çerçevesinde değişik anlamlar kazandığını belirtmek gerekiyor. Kentlerin imgesi de buna bağlı olarak silueti, simgeleri, yaşayan yanı, gecekonduları, sokakları, gürültüsü, geceleri, fantastik görünümleri ile anlam kazanmaktadır.

Aims The present meta-analysis aims to assess the evidence regarding the diagnostic accuracy and performance characteristics of the colorimetric redox indicator (CRI) assay with a special emphasis on the use of the resazurin microtiter assay (REMA) for determination of primary anti-tuberculosis drug resistance. Subject and methods By updating previous literature searches in Medline PubMed, ISI Web, Web of Science and Google academic databases of the REMA test for determination of primary anti-tuberculosis drug resistance, this meta-analysis includes 14 studies for isoniazid (INH); 15 studies for rifampicin (RIF); 6 studies for streptomycin (STR); and 5 studies for ethambutol (EMB). SROC curve analysis was performed for meta-analysis and diagnostic accuracy was summarized. Results Pooled sensitivity was 96% (94–98%) for INH, 97% (95–98%) for RIF, 92% (87–96%) for EMB and 92% (88–95%) for STR. Pooled specificity for INH, RIF, EMB and STR was 96% (95–98%), 99% (98–99%), 86% (81–89%) and 90% (87–93%), respectively. Susceptibility testing results had been obtained in 8–9 days. Conclusion In conclusion, REMA seems to be a reliable test for the determination of multi-drug resistant (MDR) isolates in laboratories with limited resources. However, few studies for STR and EMB have been found, and cost-effectiveness studies need to be determined to recommend its widespread use.